| 1 | 1 | | 86R13607 MM-D |
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| 2 | 2 | | By: Lucio III H.B. No. 4530 |
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| 3 | 3 | | |
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| 4 | 4 | | |
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| 5 | 5 | | A BILL TO BE ENTITLED |
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| 6 | 6 | | AN ACT |
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| 7 | 7 | | relating to a review of Medicaid dental services provided to |
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| 8 | 8 | | children. |
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| 9 | 9 | | BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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| 10 | 10 | | SECTION 1. (a) In this section: |
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| 11 | 11 | | (1) "Abuse" and "fraud" have the meanings assigned by |
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| 12 | 12 | | Section 531.1011, Government Code. |
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| 13 | 13 | | (2) "Commission" means the Health and Human Services |
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| 14 | 14 | | Commission. |
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| 15 | 15 | | (3) "Office of inspector general" means the |
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| 16 | 16 | | commission's office of inspector general. |
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| 17 | 17 | | (b) The office of inspector general shall conduct a thorough |
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| 18 | 18 | | review of the provision of Texas Health Steps therapeutic dental |
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| 19 | 19 | | benefits to children to determine whether fraud, waste, or abuse is |
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| 20 | 20 | | probably occurring with respect to the provision of those benefits. |
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| 21 | 21 | | The office shall conduct the review in conjunction with other |
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| 22 | 22 | | appropriate divisions of the commission and collaborate with and |
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| 23 | 23 | | seek input from stakeholders in the dental industry in this state. |
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| 24 | 24 | | (c) In determining whether fraud, waste, or abuse is |
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| 25 | 25 | | probably occurring in the provision of Texas Health Steps |
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| 26 | 26 | | therapeutic dental benefits to children, the office of inspector |
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| 27 | 27 | | general and the commission shall: |
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| 28 | 28 | | (1) review a randomly selected representative sample |
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| 29 | 29 | | of those services in a quantity sufficient to allow for the |
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| 30 | 30 | | extrapolation of results; and |
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| 31 | 31 | | (2) use the American Academy of Pediatric Dentistry |
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| 32 | 32 | | clinical guidelines and appropriate pediatric dentist peer review |
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| 33 | 33 | | to: |
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| 34 | 34 | | (A) determine dental necessity for provided |
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| 35 | 35 | | services; and |
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| 36 | 36 | | (B) assess other factors relevant to determining |
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| 37 | 37 | | whether fraud, waste, or abuse is probably occurring. |
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| 38 | 38 | | (d) Not later than November 1, 2020, the office of inspector |
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| 39 | 39 | | general and the commission shall submit a joint report on the |
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| 40 | 40 | | results of the review to the standing committees of the senate and |
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| 41 | 41 | | house of representatives having primary jurisdiction over |
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| 42 | 42 | | Medicaid. The report must include: |
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| 43 | 43 | | (1) a description of any policy changes implemented |
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| 44 | 44 | | through commission rules as a result of the review; and |
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| 45 | 45 | | (2) recommendations for statutory changes, including |
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| 46 | 46 | | any proposed legislation, to address any fraud, waste, and abuse |
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| 47 | 47 | | identified as probably occurring in the provision of Texas Health |
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| 48 | 48 | | Steps therapeutic dental benefits to children. |
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| 49 | 49 | | SECTION 2. This Act takes effect September 1, 2019. |
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